<p>
    <label for="cc_number">Credit card number</label>
    <input type="text" name="cc_number" id="cc_number" autocomplete="off" />
</p>
<p>
    <label>Expiration date</label>
    <input type="text" name="cc_exp_month" size="2" id="cc_exp_month" />
    <input type="text" name="cc_exp_year" size="4" id="cc_exp_year" />
</p>
<p>
    <label for="cc_cvv">CVV</label>
    <input type="text" name="cc_cvv" size="4" id="cc_cvv" autocomplete="off" />
</p>
